AHA Webinar January 14, 2015 Gary S. Kaplan, MD, FACP

AHA WebinarJanuary 14, 2015

Gary S. Kaplan, MD, FACP, FACMPE, FACPEKimberly Pierce-Boggs, MA

Kimberly Pierce-Boggs, MAExecutive Director, Alliance of Independent

Academic Medical Centers (AIAMC)

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The Alliance of Independent Academic Medical Centers (AIAMC) is a national membership organization made up of 80 major academic medical centers and health systems. AIAMC members:

◦ Operate independently of medical school ownership or governance while maintaining major medical school affiliations.

◦ Regard medical education and research as strategic assets in providing patient-centered care.

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The mission of the AIAMC is To assist members in achieving the highest standards of patient care through the integration of medical education and research into their clinical missions.

And, our vision is thatThe AIAMC will be an essential national resource for developing and sharing best practices in medical education and research.

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BOD Planning committee formed in 2006

The public and profession acknowledge quality and safety are falling short.

Hospitals and healthcare systems are seeking rapid improvements in patient care.

Residents play an important role in patient care at teaching institutions.

Resident quality improvement efforts, shared across multiple programs, have the potential to improve care more quickly and effectively. NI I 03/2007

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Residents have always been aware and responsive to efforts to improve quality of care and patient safety.

Residents have not generally been visible in these efforts.

“On the national level, residents are invisible in the patient safety journey”

-Jim Conway, Former Sr. Vice President, Institute for Healthcare Improvement

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Requirement- Meeting with C-suite Align with Institutional Goals 18 Months 19- 35 Institutional Participants 4 On-Site Meetings Monthly Conference Calls Academic Publications

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Hand Offs 1,2 & 3 Infection Control 1,2 Transitions of Care 1,2 & 4 Communication 2 Readmissions 2 Faculty development 3 Resident Quality Council 3 & 4 Patient Safety 1,2,3 &4 Quality improvement 1,2, 3 & 4 Professionalism 4

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NI I: Individual Leaders

NI II: Team Project

NI III & IV: Build a Sustainable QI Program Housewide

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Projects Intentionally Aligned with Institution’sStrategic Goals

Just Do It- get started

Team Approach and Focus – have to be part of the team

C-suite and Program Director buy-in are key

Involve resident in the “operations”

Goal setting bi-directional with institution

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Integrating Quality Improvement and GME into Virginia Mason’s

Strategic Mission

Gary S. Kaplan, MDChairman and CEO

• Integrated health care system

• 501(c)3 not‐for‐profit• 336‐bed hospital• Nine locations• 500+ physicians

• 5,500+ employees• Graduate Medical Education

• Research Institute• Foundation• Virginia Mason Institute 

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• Poor quality health care = 3% defect rate and costs the U.S. billions of dollars

• Health care is unaffordable and unavailable to millions of people

• Health care workers are negatively impacted by unreliable systems

© 2014 Virginia Mason Medical Center

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Q: A: O:S:W:

Q = A × (O + S) WQuality

AppropriatenessOutcomesService Waste

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We adopted the Toyota Production System key philosophies and applied them to healthcare

1. The patient is always first2. Focus on the highest quality and

safety3. Engage all employees4. Strive for the highest satisfaction5. Maintain a successful economic

enterprise

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Patient is at the top of our strategic pyramid GME integrates with “Patient First” approach ◦ “Four Habits” training: residents along with faculty ◦ Improvement events embed patient experience ◦ Systems based practice elective time with patient

relations team◦ Resident projects Example: Patient Satisfaction with Information in the

Hospital

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First, do no harm

Henry Otero MD

Priority Zero Defects

First priority, zero defects

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Embedding mistake proofing into everything we do Patient Safety Alert (PSA) Standard Work

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REPORTING

RESOLUTION TEAMS

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Systems Based Practice Elective: Understanding larger system of health care - enrollment increasing exponentially◦ Delivery systems (appropriateness)◦ Resource use for quality care (Quality Metrics,

Transparency)◦ Patient Advocacy (Patient Relations)◦ Improving care (VMPS Management Method)

Goal: 100% participation in RPIW or Kaizen Event by graduation

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Clinical Pathways Esophagectomy Patient Safety Alert Communication Process Inpatient Sepsis Prescription Refill Performance Feedback Early Recovery after Liver and Pancreatic Surgery Pre-op Carbo Loading Order Flow Clinical Pathways: Low Risk Chest Pain Standardizing Discharge Summaries Glycemic Control Real-time Improvement GI Bleed Clinical Value Stream Improving Flow of Operators in Hospital Admission Center

An effective quality improvement curriculum for residents

Presented by Camille Johnson, MD

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98,000

Resident Projects and Results

Electronic communication to Residents

3 Days 50%

Time from message sent to read

Percentage of times the message was never read

After Kaizen

• Sorting tool• Standard 

formatting• Newsletter

3 Hours 0%

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NI 1: Handoffs

NI 2: Attestation Time Out

NI 3: Feedback

NI 4: Health Literacy

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Internal Medicine and Surgery Resident Teams develop shift to shift handoff tool

Spread to operations

Embedded in Electronic Medical Record

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“Would you tell me if I were going to operate on the wrong lung?”

“No.”

“Why not?”

“I don’t know you that well. You might yell at me.”

Attending Surgeon

Surgery Technician

Anesthesia Resident

This really happened…

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New Process◦ Engaged entire team◦ Each team member introduces self, responsibility

and attests to what they know about the procedure◦ Spread to all procedural areas

Scholarly Presentations and Publication Joint Commission Surveyors

Best Procedural Pause ever observed. “You should patent and sell it!”

© 2009 Virginia Mason Medical Center

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Align the educational and operational value streams and goals

Foster resident learning of improvement methods

Encourage/enable residents to implement quality improvements

Residents are leaders and drivers of quality improvement and patient safety

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-Provide opportunities for voices to be heard

-Visible leadership

-Organizational transparency

-Staff involved in improving their own work

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“In times of change, learners inherit the earth, while the learned find themselves beautifully equipped to deal with a world that no longer exists.”

Eric Hoffer